PILLS GAIN GROUND
States that banned procedure turn their attention to medication
Above: anti-abortion activists rally Jan. 23 outside the u.s. supreme court in Washington during the March for Life. .
Left: an abortion-ights activist holds a box of mifepristone pills during a March 26, 2024, rally outside the supreme court
ABORTION
As states that banned abortion look to further restrict access this year, much of the focus is on pills sent by out-of-state providers. Survey results
A Guttmacher Institute survey released March 24 suggests that in 2025, for the first time, more women in the 13 states that ban abortion at all stages of pregnancy obtained pills through telehealth than traveled to states where abortion is legal.
The prescriptions came from providers in states with laws — adopted since the U.S. Supreme Court overturned Roe v. Wade nationwide protections in 2022 — that are intended to protect those who prescribe abortion pills to patients in states with bans.
Most often, women who use pills for abortion are prescribed two drugs: mifepristone and misoprostol. They're approved for use in the first 10 weeks of pregnancy.
The Food and Drug Administration last year approved a generic version of mifepristone, which frustrated abortion opponents.
The estimated increase in the mailing pills comes as Guttmacher's estimates also suggest fewer women travel to obtain abortions in states like Colorado, Illinois, Kansas and New Mexico.
Guttmacher's estimates are based on data from a monthly survey conducted among a random sample of U.S. abortion providers, combined with historical data from every provider in the U.S. They reflect a trend documented in other surveys of abortion providers.
Steps taken
South Dakota Gov. Larry Rhoden, a Republican, signed a bill this year that makes it a felony to advertise, distribute or sell abortion pills.
Similar measures cleared both legislative chambers this year in Mississippi, where the House and Senate need to iron out differences.
A survey of state abortion policies from Guttmacher, which supports abortion rights, found at least three states — Florida, Oklahoma and Texas — have laws that specifically ban providers from mailing the pills to patients. Louisiana classified mifepristone as a controlled dangerous substance.
Bills intended to keep out the pills cleared one chamber in Arizona, Indiana and South Carolina this year.
Court battles
Multiple states challenged the federal rules that allow mifepristone to be prescribed via telehealth. Requiring in-person prescriptions instead would dent the ability of out-of-state providers to get pills into states with bans.
Louisiana has such a lawsuit in federal court there; the attorneys general of Florida and Texas have one in Texas; those two states, along with Idaho, Kansas and Missouri, made the same case in a Missouri court.
Meanwhile, Texas filed civil cases and Louisiana criminal ones against providers accused of sending pills into their states.
Ban's fate uncertain
Wyoming is the only state this year that imposed a new abortion ban. It became the fifth state with a ban on abortion at about six weeks' gestational age — before many women realize they're pregnant. Like most other states with bans, Wyoming's law bans abortions once cardiac activity can be detected.
Courts rejected the state's previous efforts to limit abortion, and the Wyoming Supreme Court in January struck down a ban on abortion at all stages of pregnancy.
Punishing women
No state adopted a measure intended to allow criminal prosecutions against women who have abortions. The furthest such a bill advanced was a hearing last year before a Senate subcommittee in South Carolina.
Pregnancy Justice, which advocates for the rights of pregnant people, says it tracked new "abortion-as homicide" measures introduced in six states this year — down from 13 states last year.
The major established anti-abortion groups oppose the approach. "Women require compassion and support," said Ingrid Duran, the state legislative director for National Right to Life. "Not prosecution."
Melissa Murray, a professor at New York University School of Law, said that by introducing bills with penalties against women, the movement's less compromising abolitionists can break down the idea that such policies are off-limits.
She noted women sometimes are charged with crimes related to abortion. Police in Georgia recently charged a woman with murder after she allegedly used an abortion pill and the opioid painkiller oxycodone.
On ballots
Abortion questions will be before voters in at least three states in November. Missouri lawmakers ask voters to repeal the right to reproductive freedom put into the state constitution in 2024.
In Nevada, a state constitutional amendment to allow abortion until fetal viability — generally considered to be sometime after 21 weeks of pregnancy — passed in 2024, and needs a second voter approval to go in effect.
A Virginia ballot measure would guarantee the right to reproductive freedom, including access to contraception and making decisions on abortion care during the first two trimesters of pregnancy.
